MEDICARE: LISA E GOODWIN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3024	TX

General Provider Information

NPI Number	:	1912120585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA E GOODWIN LPC

Provider Business Mailing Address
First Line	:	7272 WURZBACH RD STE 601
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4803
Country	:	US
Telephone Number	:	210-615-8880
Fax Number	:	210-615-2279

Provider Business Practice Location Address
First Line	:	7272 WURZBACH RD STE 601
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4803
Country	:	US
Telephone Number	:	210-615-8880
Fax Number	:	210-615-2279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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